Incremental value of exercise echocardiography over exercise electrocardiography in a chest pain unit

European Journal of Internal Medicine
Alberto Bouzas-MosqueraJosé M Vázquez-Rodríguez

Abstract

Limited data are available on the added value of exercise echocardiography (ExEcho) over exercise electrocardiography (ExECG) in patients with suspected acute coronary syndromes (ACS) referred to a chest pain unit. We aimed to assess the incremental value of ExEcho over ExECG in this setting. ExECG and ExEcho were performed in parallel in 1052 patients with suspected ACS, nondiagnostic but interpretable electrocardiograms, and negative serial troponin results. The primary outcome was a composite of coronary death, nonfatal myocardial infarction or unstable angina with angiographic documentation of significant coronary artery disease within 6 months. The primary outcome occurred in 2/614 patients (0.3%) with both negative ExECG and ExEcho, 3/60 (5%) with positive ExECG and negative ExEcho, 73/135 (54.1%) with negative ExECG and positive ExEcho, 106/136 (77.9%) with both positive ExECG and ExEcho, and 8/107 (7.5%) with inconclusive results. The addition of ExEcho data to a model based on clinical and ExECG data significantly increased the c statistic from 0.898 to 0.968 (change +0.070, 95% confidence interval 0.052-0.092), with a continuous net reclassification improvement of 1.56 and an integrated discrimination improvement of 2...Continue Reading

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Citations

Nov 3, 2015·European Journal of Internal Medicine·Alberto Bouzas-MosqueraJosé Manuel Vázquez-Rodríguez
Jan 18, 2016·European Journal of Internal Medicine·Alberto Bouzas-MosqueraJosé Manuel Vázquez-Rodríguez
May 3, 2016·The American Journal of Emergency Medicine·Alberto Bouzas-MosqueraJosé Manuel Vázquez-Rodríguez
Dec 28, 2016·European Journal of Emergency Medicine : Official Journal of the European Society for Emergency Medicine·Alberto Bouzas-MosqueraJosé M Vázquez-Rodríguez

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